DESCRIPTION (provided by investigator): Introduction: Numerous adverse consequences (death, fracture, aspiration and delirium) have been reported to be the direct or indirect result of physical restraint (PR). Given PR's serious threat to patient safety, especially that of the elderly, Health Care Finance Administration regulations mandate the restriction of PR use. Although efforts to reduce PR in nursing homes have demonstrated success, the variables associated with hospital PR use have not been identified. Safe PR reduction is of special concern to intensive care unit clinicians because of the real threat to safety posed by patients' premature disruption (e.g. self-extubation) of life sustaining therapies or by falls. Defining the extent and context of PR use and of therapy disruption is hampered by the lack of available national data. Purpose/Aims: This three year prospective study seeks to (1) determine the scope and variation in physical restraint use in non-psychiatric acute care settings, (2) identify the extent to which administratively mediated variables explain PR use variation, and (3) identify the rates, contexts and consequences of therapy disruption for restrained and unrestrained intensive care unit (ICU) patients in the elderly and non-elderly populations. Methods/Design: A three year, prospective unit level study of 40 randomly selected acute care general hospitals in five metropolitan areas (New York, Chicago, Houston, Denver and Phoenix) will include: (A) a PR prevalence and context determination for all non-psychiatric, non-emergency, non-operative, non-long term care units through an 18 randomly selected day observational method (Aim l) (B) an examination of the ability of selected labor, capital and organizational variables to explain PR use on the three highest usage type units (n=120 units). [Highest usage types are those determined in step A]. (Aim 2) (C) a 90 day prospective study of one adult ICU in each hospital (n=40 units) (Aim 3). Descriptive, correlational, and multi-level statistical analyses will be conducted. Health Related Implications: The results will (1) inform public policy debates related to the priority for further PR reduction efforts (2) assist in the development of effective PR reduction efforts through determination of the role of labor, capital and organizational variables (3) provide information regarding the effectiveness of PR in preventing therapy disruption in ICUs where resistance to restraint reduction is based on provider concerns for patient safety, and (4) help determine the extent and sequelae of therapy disruption to allow for later exploration of its effects on the costs and quality of care.